Palliative Care Knowledge and Planning in U.S. Adults

Abstract Palliative care knowledge and health literacy are frequently underestimated in American adults; for example, as measured by the Newest Vital Sign (Weiss et al., 2005), 79.2% (n = 247) of participants within a Geriatrics Clinic sample displayed “adequate” functional health literacy, while 11.8% (n = 37) scored within the “possibly limited” range, and 9.0% (n = 28) scored within the “highly limited” range. There was additionally a significant association between health literacy and age (r = .15, p < .01) within this sample. The Palliative Care Knowledge Scale (PaCKS; Kozlov et al., 2018) was administered to participants, and higher scores indicated a greater knowledge of palliative care. This construct is particularly important to measure, as racial/ethnic disparities exist within this domain; for example, African Americans may have lower overall knowledge of palliative care services and advance care planning than non-Hispanic Whites (Noh et al., 2018). In the current study, knowledge of palliative care was measured using the PaCKS (Kozlov et al., 2018), and scores represented the widest possible range of 0 to 13 (M = 7.68, SD = 4.08). There was a significant correlation between age and PaCKS score (r = .12, p < .05), as palliative care knowledge increased with age. Females scored significantly higher (M = 8.29, SD = 3.91) than males (M = 6.81, SD = 4.18), t(309) = 3.18, p < .001. There was no main effect of race on palliative care knowledge, and post-hoc analysis using Tukey HSD did not demonstrate significant differences between groups.


Results:
The study found that African Americans have a longer length of stay in hospice agencies than Whites, even after controlling for all other factors in the model. Female gender, older age, and several diseases are covariates that significantly impact length of hospice stay.
Discussion: Compared to other races/ethnicities, the long length of stay in hospice among African Americans may negatively impact the quality of end-of-life care and quantity of skilled staff visits. Future research is recommended to further explore potential consequences of longer hospice stays, especially within African American communities. Studies with larger samples of minorities that integrate socioeconomic factors need to be done to better study the relationship between length of hospice stay and race/ethnicity.

OLDER COUPLES' ADVANCE CARE PLANNING ENGAGEMENT PATTERNS AND ASSOCIATIONS WITH INDIVIDUAL AND SPOUSAL FACTORS
Hyo Jung Lee, 1 and Bon Kim,2 ,1. Nanyang Technological University,Singapore,Not Applicable,Singapore,2. Jeju National University,Republic of Korea This study examines older couples' dyadic patterns of informal and formal advance care planning (ACP) and determines the associations of these patterns with their own and spousal characteristics. Using data from the 2014 and 2016 Health and Retirement Study, we performed a) latent class analysis to identify distinctive ACP engagement patterns and b) multinomial regression models to describe related characteristics of older couples (N = 1,545 couples). We identified four dyadic patterns of ACP engagement: a) high ACP engaging couple (45%); b) high engaging husband -low engaging wife (13%); c) high engaging wifelow engaging husband (11%); and d) low engaging couple (31%). Engagement in informal and formal ACP was associated with both individual and spousal factors: Older couples with advanced age or higher levels of education and wealth were more likely to engage in both informal and formal ACP, whereas only wife's high level of constrain or husband's greater number of depressive symptoms was associated with discordant ACP engagements. Couple-based approach to promote ACP merits older couples with limited resources or poorer psychological health in both or either spouse.

PALLIATIVE CARE KNOWLEDGE AND PLANNING IN U.S. ADULTS
Amy Albright, 1 and Rebecca Allen, 2 1. VA Maine HCS, Gorham, Maine, United States, 2. University of Alabama, Tuscaloosa, Alabama, United States Palliative care knowledge and health literacy are frequently underestimated in American adults; for example, as measured by the Newest Vital Sign (Weiss et al., 2005), 79.2% (n = 247) of participants within a Geriatrics Clinic sample displayed "adequate" functional health literacy, while 11.8% (n = 37) scored within the "possibly limited" range, and 9.0% (n = 28) scored within the "highly limited" range. There was additionally a significant association between health literacy and age (r = .15, p < .01) within this sample. The Palliative Care Knowledge Scale (PaCKS; Kozlov et al., 2018) was administered to participants, and higher scores indicated a greater knowledge of palliative care. This construct is particularly important to measure, as racial/ethnic disparities exist within this domain; for example, African Americans may have lower overall knowledge of palliative care services and advance care planning than non-Hispanic Whites (Noh et al., 2018). In the current study, knowledge of palliative care was measured using the PaCKS (Kozlov et al., 2018), and scores represented the widest possible range of 0 to 13 (M = 7.68, SD = 4.08). There was a significant correlation between age and PaCKS score (r = .12, p < .05), as palliative care knowledge increased with age. Females scored significantly higher (M = 8.29, SD = 3.91) than males (M = 6.81, SD = 4.18), t(309) = 3.18, p < .001. There was no main effect of race on palliative care knowledge, and posthoc analysis using Tukey HSD did not demonstrate significant differences between groups.
Chaplaincy Network,New York,New York,United States,5

. University of Texas, Austin, Texas, United States
Healthcare chaplains have key roles in palliative care including facilitating advance care planning (ACP). However, little is known about chaplains' competency in ACP. We conducted an online survey with board-certified healthcare chaplains recruited from three major professional chaplains' organizations. We explored correlates of chaplains' competency in ACP facilitation among two groups of chaplains, general and special care (SC) chaplains (chaplains in oncology, intensive care, or palliative units) because SC chaplains are generally more involved in palliative care. The final sample included 481 chaplains with 89.8% reporting ACP as an important part of their work and 71.3% reporting to help patients complete advance directives. There was no significant difference in ACP competency between general chaplain group (n=240; M=39.61, SD=7.0) and SC chaplain group (n=241; M=40.65, SD=5.87). Hierarchical regression analyses revealed differences between the groups. General chaplains who practiced longer as a chaplain (b=1.02, p<.000), were more engaged in ACP facilitation (b=1.06, p<.05), had more positive attitude toward ACP (b=4.04, p<.000), and reported a higher level of participation in shared decision-making with other team members (b=.75, p<.000) were more competent in ACP facilitation. In the SC chaplain group, higher competency was associated with more positive attitude towards ACP (b=2.58, p <.05), and a higher level of participation in shared decision-making (b=1.05, p <.000). Overall, these findings suggest that healthcare chaplains, both general and special care, are competent and actively involved in ACP facilitation. Further systematic studies are warranted to examine the effects of chaplains facilitating ACP on patient and healthcare system outcomes. Sara Hackett, University of South Florida , Wesley Chapel, Florida, United States Recent research integrating the hierarchical mapping technique (HMT) and the continuing bonds framework has suggested that deceased individuals may be influential social convoy members. Building off this pilot work, the current qualitative descriptive study focused on how older women viewed the role of a longstanding deceased romantic partner in their current social network. Twenty women (Mean age = 78 years), recruited via social media and snowball sampling, participated in one 90-minute semi-structured interview. Each discussed their bereavement journey and completed a HMT diagram to comment on their social network and the presence or absence of the deceased within it. Nineteen participants described the deceased as being an active member of their convoy. Interestingly, 15 women placed them within the innermost circle of the diagram, separate from their other network members. Thematic analysis of interview transcripts expanded upon the HMT diagram exercise to reveal five major themes: "We're part of each other," "I think he supports me," "He would want me to be happy," "I just feel so grateful," and "I think about him every day but I don't talk about him every day". Perceptions that deceased romantic partners continue to play a key role in participants'